Download Dental User Manual

Commonwealth of Kentucky
KY Medicaid
KyHealth Net Dental
Companion Guide
Version 6.2
Revised October 8, 2010
Revision History
Document
Version
Date
Name
Comments
1.0
12/27/2006
Patti George
Created.
2.0
12/27/2006
Ron Chandler
Review and format.
2.1
01/29/2007
Patti George
Updates per DMS walkthrough.
3.0
02/09/2007
Lize Deane
Formatted according to KY standards.
3.1
02/26/2007
Michelle Goins
Updated with latest information.
4.0
02/26/2007
Patti George
Updates.
5.0
03/06/2007
Ann Murray
Updated according to comments.
6.0
10/20/2008
Cathy Hill
Updated screens and text as directed.
6.0
3/12/2009
Cathy Hill
Changed text references from KyHealth
Choices to KY Medicaid
6.1
4/28/2010
EDI
Revised per EDI.
6.2
10/6/2010
Martha Senn
Marilyn Surratt
Stayce Towles
Revised per EDI.
6.2
10/8/2010
Martha Senn
Marilyn Surratt
Stayce Towles
Ron Chandler
Remove PHI. Format to DMS
standards.
Commonwealth of Kentucky - MMIS
KyHealth Net Dental Companion Guide
Ta b le o f Co n te n ts
1
To Create a New Provider user account for KYHealthnet. ............................................................. 1
1.1 How to receive your Pin number:.................................................................................................. 1
1.2 Creating a New Account ............................................................................................................... 2
2
S ig n in g in to KyHe a lth Ch o ic e s .......................................................................................................... 5
2.1 Sign into KyHealth Choices .......................................................................................................... 5
2.2 Accessing User Applications ........................................................................................................ 6
2.2.1
How to Change the Password: ...................................................................................... 9
2.2.2
Email examples of password reminder and account change notification ..................... 9
2.3 Viewing Agent Roles ................................................................................................................... 11
2.4 Add an Agent or New Employee................................................................................................. 11
2.4.1
No Email Address Found: Create Username .............................................................. 12
2.5 Manage Agent Roles .................................................................................................................. 15
3
Ac c e s s in g KY He a lth Ne t ................................................................................................................. 18
4
Fu n c tio n a lity ...................................................................................................................................... 19
5
Me m b e r Elig ib ility Ve rific a tio n ......................................................................................................... 21
5.1 To Search Select Lookup Type: ................................................................................................. 21
5.2 View Pharmacy Claim History .................................................................................................... 23
6
S p e n d d o wn ....................................................................................................................................... 24
7
P A - P rio r Au th o riza tio n ................................................................................................................... 25
7.1 PA Letter list................................................................................................................................ 26
7.2 PA Inquiry ................................................................................................................................... 27
8
P ro vid e r Re fe re n c e s ......................................................................................................................... 29
8.1 Reference Search ....................................................................................................................... 29
8.2 TPL Carriers ................................................................................................................................ 31
8.3 Provider References Documentation .......................................................................................... 32
9
RA Vie we r .......................................................................................................................................... 33
9.1 Claims ......................................................................................................................................... 35
9.2 Claim Inquiry: .............................................................................................................................. 36
9.3 Submitting Dental Claim ............................................................................................................. 37
9.4 Verify Provider Box ..................................................................................................................... 38
9.5 Dental Claim ............................................................................................................................... 39
Appendix A: ................................................................................................................................ 46
9.5.2
Forms .......................................................................................................................... 46
9.5.3
Billing Instructions ....................................................................................................... 46
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KyHealth Net Dental Companion Guide
1 To Create a New Provider user account for KYHealthnet.
The user creating the KY Healthnet account should be the office manager or someone deem
responsible for accessing provider information. A pin number is required to create a user
account. The EDI Helpdesk will assign a pin number to each KY Medicaid provider id.
1.1
How to receive your Pin number:
1. Go to KY Medicaid Website www.kymmis.com ;
2. Click on Electronic Claims;
3. Click on Frequently Asked Questions;
4. Click on the hyperlink at the bottom of page last paragraph first sentence for pin release
form (user instructions included);
5. Complete the attached PIN Release form and return to EDI Helpdesk along with a
copy of a valid driver's license via e-mail or fax. Include your phone # and e-mail
address and someone will contact you with your PIN and website information;
6. Fax your PIN Release form to: 502-209-3242 or 502-209-3200
7. E-mail your form to: [email protected]
8. The HP EDI department will respond within 2 business days via email:
9. The Pin release email example is below :
From: [email protected]
Sent: Monday, August 9, 2010 10:30 AM
To: [email protected]
Subject: KY Medicaid pin release request
To create a KY Health Net account user the following information:
Provider id = XXXXXXXXXX
PIN # = XXXXXXXXX
To create a KYHealth Net account, access https://public.kymmis.com/pinletter/
To access the user account: http://home.kymmis.com/
The password expires every 30 days. A reminder is sent on the 20th day to update the password.
To change your password click on Account Management, Change my password.
In the future you can do the following:
If the account user password is expired click on 'Forgot my password' button on the sign in page
under password to complete a password update. This function only works if a security question
is linked to the account.
If you have questions contact the EDI Helpdesk at 800.205.4696 or [email protected].
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1.2
KyHealth Net Dental Companion Guide
Cre a tin g a New Ac c o u n t
1. Enter the provider ID (KY Medicaid provider id or Group id); and,
2. Enter the PIN number assigned.
3. User Agreement to Terms of Service window will display,
4. Click the ‘Yes, I agree” or “No, I do not agree” button.
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KyHealth Net Dental Companion Guide
5. Enter the data On the “Create New Account” Form
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KyHealth Net Dental Companion Guide
6. The “Your account was successfully created” window will display.
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2
2.1
KyHealth Net Dental Companion Guide
S ig n in g in to KyHe a lth Ch o ic e s
S ig n in to KyHe a lth Ch o ic e s
7. Access https://home.kymmis.com
8. Enter the username and password
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2.2
KyHealth Net Dental Companion Guide
Ac c e s s in g Us e r Ap p lic a tio n s
1. Click on “Account Management” under “Application”.
The Administrator to the provider account can view or add Agents. An agent has limited access
to change password or update security questions.
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2. Account Management screen displays;
The functionality available is
Account Home – click and return to home page (Admin and Agent)
My Information – allows user to update address, phone number and security question.
(Admin and Agent)
Change Password – allows user to change the current password (Admin and Agent)
View Agent Roles – allows the provider administrator to view the roles granted to an
agent.
Add Agent – allows the provider administrator to add agents.
[email protected]
3. click on the “My Information” button the following screen displays;
4. Scroll to the “Security Question & Answer” section;
5. Select the security question;
6. Enter the answer;
7. Click on Save.
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2.2.1 How to Ch a n g e th e P a s s wo rd :
The account password expires every 30 days. A pink banner will display on the Home page
with a countdown of days prior to password expiration beginning with 10. The user will receive
an email notification from MEUPS prior to the expiration on the 20th day.
8. Click on the “Change Password” button;
9. Complete form;
10. Click the “Change Password” button.
2.2.2
Em a il e xam p le s o f p a s s wo rd re m in d e r a n d a cc o u n t c h a n g e n o tific a tio n
From: MEUPS Automated Mailer [mailto:[email protected]]
Sent: Friday, July 16, 2010 1:30 PM
To: Doe, Jane
Subject: PASSWORD EXPIRATION REMINDER: 10 days left
Sensitivity: Confidential
Kentucky user Jane Doe,
Your Medicaid system account password will expire in 10 days on Monday, July 26, 2010. Please change
your password before then to ensure uninterrupted system access.
Please contact the EDS helpdesk at [email protected] or call (800) 205-4696 between 7:00
am - 6:00 pm Monday - Friday EST should you have questions regarding this notification.
Medicaid Enterprise Users Provisioning System
MO
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From: MEUPS Automated Mailer [mailto:[email protected]]
Sent: Wednesday, August 18, 2010 2:00 PM
To: Doe, Jane
Subject: ACCOUNT CHANGE NOTIFICATION
Sensitivity: Confidential
Kentucky user Jane Doe,
KyHealth Choices sends you this account change notification for your information. No action on your part
is required. The following changes have been made recently against your systems account:
Date of Change
Description
Aug 18 2010
1:30PM
Account access has been reinstated
Aug 18 2010
1:32PM
Password changed
Please contact the EDI helpdesk at [email protected] or call (800) 205-4696 between 7:00 am
- 6:00 pm Monday - Friday EST if you have questions about any of these changes.
KyHealth Choices
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2.3
KyHealth Net Dental Companion Guide
Vie win g Ag e n t Ro le s
“View Agent Roles” button user may see the “No agents found” screen as shown below when
no agents have been added to the provider account.
(Shown for provider admin and billing agent user accounts)
2.4
Ad d a n Ag e n t o r Ne w Em p lo ye e .
(For provider admin and billing agent user accounts)
Enter email address of agent to search or create an account.
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2.4.1 No Em a il Ad d re s s Fo u n d : Cre ate Us e rn am e
1. Complete the fields boxed in red below,
2. Click “Add & Manage Agent” button.
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3. The “Agent Account Created” window appears and;
4. User will receive an email as shown below:
Automated MEUPS email Example:
5. When user clicks the link in the email (example above), the “Terms of Service User
Agreement window appears as shown below;
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6. User must click “I agree” in order to proceed.
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2.5
KyHealth Net Dental Companion Guide
Ma n a g e Ag e n t Ro le s
1. Allows user to add and/or remove roles from the agent;
2. Click on the “KYHealthNet”link.
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3. Notice the
KyHealth Net Dental Companion Guide
Modify the permissions for KYHealthNet” section opens;
4. Roles are granted or removed in this section
5. Click the “Save Changes” button to save modifications;
6. The screen returns “Successful…”
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3
KyHealth Net Dental Companion Guide
Ac c e s s in g KY He a lth Ne t
1. On the “KyHealth Choices Home” page click on the “KYHealth Net” link;
2. Verify Provider – NPI – Taxonomy in drop down box
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4
KyHealth Net Dental Companion Guide
Fu n c tio n a lity
Roles are granted by the administrator; if user (agent account) does not have access to
one of the following tabs contact the administrator of the account.
Provider Home – Displays all functionality user has access
Member - User has access to Card Issuance, Eligibility Verification, Pharmacy History,
Presumptive Eligibility, Patient Liability and Spend down.
Claims – Claim inquiry and Submit Dental claim
PA - PA Checklist, Radiology Prior Auth Proc Code list, PA letter and PA Inquiry
Provider References – Reference Search, TPL Carrier and Documentation
RA Viewer – allows user to view 6 months of RA.
Included in the next pages is Member selections Card Issuance:
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1. Enter the Member ID or SSN# and click the “Search” button to find the Medicaid card
issue date.
The card issuances dates include begin and end dates along with issue type
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5
5.1
KyHealth Net Dental Companion Guide
Me m b e r Elig ib ility Ve rific a tio n
To S e a rc h S e le c t Lo oku p Typ e :
An example of member eligibility verification
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5.2
KyHealth Net Dental Companion Guide
Vie w P h a rm a c y Cla im His to ry
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6
KyHealth Net Dental Companion Guide
S p e n d d own
1. Enter the Member ID or SSN# and click the “Search” button to find the spend down data.
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7
KyHealth Net Dental Companion Guide
P A - P rio r Au th o riza tio n
PA Letters
Search by provider only or by a specific member
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7.1
KyHealth Net Dental Companion Guide
P A Le tte r lis t
Select the member letter under letter type
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7.2
KyHealth Net Dental Companion Guide
P A In q u iry
A PA search is completed by entering:
Transaction ID – is the PA number; or
Member ID; or
SSN; or
Name of member; or
Start date is required with all search criteria
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Selecting Search returns the Transaction ID, click to open the PA. Click on the next button to
view the Summary page.
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8
8.1
KyHealth Net Dental Companion Guide
P ro vid e r Re fe re n c e s
Re fe re n c e S e a rc h
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Enter the procedure code and date of service, select the Benefit Plan click Search. The
response will return the Limitation for the date of service.
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8.2
KyHealth Net Dental Companion Guide
TP L Ca rrie rs
Enter a insurance company to find the mailing addresses Medicaid has on file.
Enter the TPL Carrier select Search; the response will return all carrier information on file.
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8.3
KyHealth Net Dental Companion Guide
P ro vid e r Re fe re n c e s Do c u m e n ta tio n
Select Documentation for additional provider resources available at www.kymmis.com
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9
KyHealth Net Dental Companion Guide
RA Vie we r
Click RA Viewer to review the remittance advice. RA Viewer holds 6 months of RA displaying
the most current at the top of the screen. Each RA can be downloaded to the desktop or saved
to a folder.
Verify the provider NPI and Taxonomy if using an agent or billing agent account. A drop down
box is available for these accounts. Select the applicable provider to view.
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Select the applicable Run Date
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9.1
KyHealth Net Dental Companion Guide
Cla im s
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9.2
KyHealth Net Dental Companion Guide
Cla im In q u iry:
Select the applicable NPI and Taxonomy if using an agent or billing agent account.
Enter Member ID and From Date/Thru Date or Patient Acct #
ICN – Enter ICN and remove From Date/Thru Date
Claim Status – Any Status, Paid, Denied and Suspended
Date of Service – is a search for claim using the dates of service entered or
Warrant Date – Warrant Date should read as RA date
Unfinished claims – is a claim not completed but save for future submission
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9.3
KyHealth Net Dental Companion Guide
S u b m ittin g De n ta l Cla im
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9.4
KyHealth Net Dental Companion Guide
Ve rify P ro vid e r Bo x
Verify the correct NPI and taxonomy display; click on next
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9.5
KyHealth Net Dental Companion Guide
De n ta l Cla im
9.5.1.1
De n ta l Cla im He a d e r
First Column Billing Information
Second Column Service Information
Please follow Billing Instructions for Claim type when completing fields.
Appendix B: Web site link for All Medicaid Billing Instructions
Below are instructions for completing the fields
9.5.1.2 Be low this s c ree n a re in s tru c tio n s fo r fillin g in th e b lo c ks
Field# Field Description Definition of Field Description
1
Provider Number
Enter the Kentucky Health Choices NPI number. This field is autopopulated based on the previous screen selection.
2
Member ID*
Enter the Member’s Kentucky Health Choices ID number. The *
indicates that this is a mandatory field.
3
Last Name
The member’s Last name. This field is auto-populated after the
member number is entered.
4
First Name
The member’s First name. This field is auto-populated after the
member number is entered.
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Field# Field Description Definition of Field Description
5
Date of Birth
The member’s date of birth. This field is auto-populated after the
member number is entered.
6
Gender
The member’s Gender. This field is auto-populated after the
member number is entered.
7
Patient Account #
Enter the provider-assigned patient account number. This field is
optional.
8
Insurance Denied? Paper bill with attachment
9
Prior Authorization If the service requires Prior Authorization, enter the 10 digit PA
number here.
10
Service Information Identifies the “Service Information” section of the Header screen.
11
Emergency
If the service is the result of an emergency, choose “yes” from the
drop down menu. If not, leave the default selection, “no.”
12
Accident
If the service is the result of an accident, choose the type of
accident from the drop down menu. If not, leave the default
selection, “none.”
13
Accident Date
If anything other than “none” is selected from the Accident drop
down menu, enter the date of the accident. If a date is entered
indicating an accident, the claim must be filed on paper rather than
electronic.
14
EPSDT
If the service is the result of an EPSDT screening, choose “yes”
from the drop down menu. If not, leave the default selection, “no.”
15
Place of Service
Select the appropriate Place of Service from the drop down menu.
16
Rendering Provider Select the Kentucky Health Choices rendering NPI number and
matching taxonomy that is in the drop down box. The * indicates
that this is a mandatory field.
17
Claim Charges
Identifies the “Claim Charges” section of the Header screen.
18
Total Charges
This field will be auto-populated after detail charges are entered in
the detail screen.
19
TPL Amount
This field will be auto-populated after detail TPL payments are
entered in the detail screen.
20
Total Amount Paid This field will be auto-populated after all charges and payments are
entered in the detail screen.
21
Next
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Click the Next button to continue to the detail screen.
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9.5.1.3
KyHealth Net Dental Companion Guide
De n ta l Cla im De ta il S c re e n
Below are instructions for filling in the fields.
Field# Field Description
Definition of Field Description
1
Detail Information
Identifies this as the “Detail Information” section of the Details
screen.
2
Item
Line number of the detail. This field is auto-populated.
3
DOS*
Enter the date the service was provided. The * indicates that this
field is required.
4
Place of Service
Select the appropriate place of service from the drop down menu.
5
Procedure*
Enter the ADA procedure code that identifies the service provided.
The * indicates that this field is required.
6
Tooth Number
Enter the tooth number on which the procedure was performed (if
applicable).
7
Surfaces
Enter the tooth surface on which the procedure was performed (if
applicable).
8
Quadrant
Use the drop down menu to select the quadrant, if applicable.
9
Prosthesis
Use the drop down menu to select the prosthesis, if applicable.
10
Cavity Codes
Enter Arch code
11
Units*
Enter the number of units (1 is the default value). The * indicates
that this field is required.
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Field# Field Description
Definition of Field Description
12
Charges*
Enter the usual and customary charge for the procedure. The *
indicates that this field is required.
13
Status
Status of the claim (if you are accessing a previously submitted
claim).
14
Allowed Amount
The amount allowed by Kentucky Health Choices (paid claims
only).
15
Warrant Amount
Total amount of the check.
16
Save
Saves the detail line on the claim.
17
Add
Allows user to add an additional detail line.
18
Delete
Allows user to remove the detail line previously entered.
19
Next
Click on next to continue to the detail screen.
20
Print
Allows user to print this screen.
9.5.1.4
De n ta l S u m m a ry S c re e n
Below are instructions for filling in the fields.
Verify the Summary and Click on “Submit Claim”.
Options are at the bottom of each claim to void claim, adjust claim, and submit claim and print
claim.
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Field# Field Description Definition of Field Description
1
Summary
2
Billing Information Identifies this section as the “Billing Information” section of the
Summary screen.
3
Service
Information
Identifies this section as the “Service Information” section of the
Summary screen.
4
Claim Charges
Identifies this section as the “Claim Charges” section of the Summary
screen.
5
Details
Identifies this section as the “Details” section of the Summary screen.
(Click on the Detail number to return to that detail).
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Identifies this as the “Summary” screen.
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9.5.1.5
KyHealth Net Dental Companion Guide
Ad ju s t o r Vo id Cla im S c re e n
To adjust or void a paid claim select Claims Inquiry enter member information and dates of
service or enter the ICN of the claim. Click on the Next button to advance, correct the
information. Save the updated information then click on the Adjust button. To Void a claim
follow the same process to find the claim then select the Void button. If the claim does not show
a Adjust or Void Claim button the claim was previously adjusted or void.
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Field# Field Description
Definition of Field Description
1
Next
Will navigate the user through the claim.
2
Adjust
To adjust a paid claim make the correction and click save when a
save button is available.
3
Void Claim
To reverse a paid claim click on Void.
4
Print
Allows user to print this screen.
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Ap p e n d ix A:
9.5.2 Fo rm s
Web site link for blank PIN Release form:
www.kymmis.com
Click on electronic claims
Click on frequently asked questions
Read What is KYHealthnet
Click on link for PIN Release Form
9.5.3
Billin g In s tru c tio n s
www.kymmis.com
Click on Provider Relations
Click on Billing Instructions
Click on Dental
.
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